Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Respiratory Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
Ann Thorac Surg. 2019 Oct;108(4):1052-1058. doi: 10.1016/j.athoracsur.2019.04.096. Epub 2019 Jun 21.
Previous studies suggest that transbronchial lung biopsy using a cryoprobe is superior to transbronchial lung biopsy using forceps for evaluating lung grafts, although the technique can be associated an increase in complications. Because cryoprobe experience is limited, assessment of a greater number of cases is warranted. This prospective study evaluates the diagnostic yield, complications, and risk factors associated with the cryoprobe technique.
From April 2013 to April 2016, 321 consecutive cryoprobe transbronchial biopsies were indicated in single or bilateral lung transplant patients with acute or chronic clinical lung injury or in asymptomatic patients before hospital discharge after lung transplantation.
With a mean of 4.32 lung parenchyma specimens per procedure, adequate alveolar lung parenchyma was obtained in 96.6% (84.27 ± 44.14 mm) of cases. Obtaining at least 4 samples increased the histological diagnostic certainty (P < .001). Moderate to severe bleeding was observed in 7.48% of patients and was significantly more frequent in patients with unilateral transplantation (odds ratio, 0.10; 95% confidence interval, 0.02-0.30; P < .001) and in those with high blood pressure during scanning (odds ratio, 0.31; 95% confidence interval, 0.12-0.86; P = .019). Pneumothorax was observed in 7.7% of the patients, but only 3.7% of these patients required pleural drainage.
Obtaining 4 or more cryobiopsy samples is valuable and safe for lung allograft monitoring. Being a recipient of a unilateral lung transplant or having arterial hypertension during bronchoscopy seem to be risk factors associated with increased bleeding.
先前的研究表明，与使用活检钳进行经支气管肺活检相比，使用冷冻探针进行经支气管肺活检对评估肺移植物具有优势，尽管该技术可能会增加并发症。由于冷冻探针经验有限，因此需要评估更多的病例。本前瞻性研究评估了冷冻探针技术的诊断产量、并发症和相关危险因素。
从 2013 年 4 月至 2016 年 4 月，对 321 例单肺或双肺移植患者的急性或慢性临床肺损伤或肺移植后出院前无症状患者进行了连续的冷冻探针经支气管活检，这些患者均有提示性的临床和/或影像学改变。
平均每个程序获得 4.32 个肺实质标本，96.6%（84.27 ± 44.14 mm）的病例获得了足够的肺泡肺实质。获得至少 4 个样本可提高组织学诊断的确定性（P <.001）。7.48%的患者出现中度至重度出血，单侧移植（比值比，0.10；95%置信区间，0.02-0.30；P <.001）和扫描时高血压（比值比，0.31；95%置信区间，0.12-0.86；P =.019）的患者中，出血更为常见。7.7%的患者发生气胸，但只有 3.7%的患者需要胸腔引流。
获得 4 个或更多的冷冻活检样本对于监测肺同种异体移植物是有价值且安全的。作为单侧肺移植的受者或在支气管镜检查期间患有高血压似乎是与出血增加相关的危险因素。
